Presentation on theme: "WHY WON’T THIS VENOUS ULCER HEAL? Noel Parent MD, FACS, RVT SENTARA VASCULAR SPECIALISTS Virginia Beach, VA."— Presentation transcript:
WHY WON’T THIS VENOUS ULCER HEAL? Noel Parent MD, FACS, RVT SENTARA VASCULAR SPECIALISTS Virginia Beach, VA
Variety of leg ulcer etiology Decubitis (pressure) at points of contact Ischemic (arterial) malperfusion Infectious Foreign body Rheumatologic or autoimmune Venous Venous hypertension
Venous ulcer characteristics Ulcer location is medial lower calf just above the ankle Hemosiderin deposition Lipodermatosclerosis Edema Size variable Varicose veins +/-
It all begins with loss of venous valve function (venous reflux)
Importance of the perforating veins
Elevated pressure within the veins of the calf skin is the pathophysiology
How to decrease venous pressure?
Traditional surgical treatment
Why vein ulcers… …did not heal in the past: INADEQUATE DIAGNOSTIC IMAGING IMPRECISE INVASIVE TREATMENTS …why they may heal now: DUPLEX ULTRASOUND IMAGING FOR VEIN MAPPING EVLT IS PRECISE AND MINIMALLY INVASIVE
Duplex ultrasound perforator vein imaging to access for ablation
Percutaneous fiberoptic laser delivery of thermal energy
SVS Vein Center of Virginia
Perforator vein identified by duplex scan
Perforator vein cannulation
Insertion of laser fiberoptic
Ablation of perforator vein
Case example #1 Very dirty ankle venous ulcer in an elderly female. Complex PVL showing: chronic thrombus in GSV. Note associated SSV reflux and two incompetent calf perforator veins.
Case example #1, cont’d PVL confirms successful ablation of GSV, SSA and perforators. 6 weeks post endovenous laser treatment: ulcer healing for the FIRST TIME IN A YEAR!
Case example #2 Pre treatment Post treatment
Retrospective study of EVLT for venous ulcers in SVS/VCV
Compared 3 groups of patients
Incidence of ulcer healing
Improvement in VCSS
Summary Leg ulcers are commonly due to elevated venous pressure in skin from valve weakness resulting in reflux. Results from traditional therapies of Unna boots, stockings, and open surgery are disappointing. (Costly, morbid, disabling) A contemporary treatment consisting of duplex scan diagnosis of perforating veins, then treatment by EVLT, may become the new standard of care.